The latest medical research on Immunology & Allergy

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about immunology & allergy gathered by our medical AI research bot.

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Estimating the probability of diagnosis within one year of HIV acquisition.

AIDS

Early diagnosis of HIV is important for the prevention of ongoing transmission and development of HIV-related illness. The purpose of this study is to develop an outcome indicator to monitor the progress in early HIV diagnosis.

Persons diagnosed with HIV in New York City and their first CD4 test results were used to estimate the distribution of HIV diagnosis delay, based on a CD4 count depletion model. The distribution was then used to estimate the probability of diagnosis within 1 year of HIV acquisition, which is the number of cases diagnosed in a given calendar year for which diagnosis occurred within 1 year of acquisition divided by the number of incident cases in that calendar year.

In 2012-2016, the estimated annual probability of diagnosis within 1 year of HIV acquisition in New York City was 43.0% [95% confidence interval (CI): 37.9-48.2%), 42.5% (95% CI: 36.8--48.3%), 42.8% (95% CI: 36.3--49.2%), 42.9% (95% CI: 35.4--50.3%), and 42.2% (95% CI: 33.1--51.2%), respectively.

National and local health jurisdictions should consider using this new outcome indicator, the probability of diagnosis within 1 year of HIV acquisition, to monitor their progress in early HIV diagnosis.

Evolving Rhinology: Understanding the Burden of Chronic Rhinosinusitis Today, Tomorrow, and Beyond.

Current Allergy and Asthma Reports

To improve our appreciation of the burden of chronic rhinosinusitis (CRS) and to understand better how to ease that burden.

The burden of CRS is high. At an individual level, this burden is due to rhinologic symptoms as well as more systemic symptoms. At a societal level, the indirect costs of CRS, mostly due to reduced productivity, are higher than the direct costs. Surgical treatment has been found to be effective in addressing both the individual and societal burdens. Endotyping is just beginning to usher in the potential for personalized, precision treatments in CRS. We understand much about the burden of CRS but more remains to be learned, especially as newer expensive treatments become available. By appreciating the high burden of CRS, we can fulfill our mission to effectively lift that burden.

Material security and adherence to antiretroviral therapy (ART) among HIV-positive people who use illicit drugs.

AIDS

To examine the relationship between poverty, operationalized using a novel material security measure, and adherence to antiretroviral therapy (ART) among people who use illicit drugs (PWUD) in a context of universal access to HIV care.

We used multivariable generalized mixed-effects analyses to estimate longitudinal factors associated with mean material security score. We then estimated the association between achieving ≥ 95% adherence to ART and overall mean material score, as well as mean score for three factors derived from a factor analysis. The three factors structure, employed in the current analyses, were Factor 1 (basic needs); Factor 2 (housing-related variables) and Factor 3 (economic resources).

Recent incarceration [β-coefficient (β) = -0.176, 95% Confidence Interval [95%CI]: -0.288, -0.063), unmet health needs (β = -0.110, 95% CI: -0.178, -0.042), unmet social service needs (β = -0.264, 95% CI: -0.336, -0.193) and having access to social services (β= -0.102, 95% CI: -0.1586, -0.0465) were among the factors associated with lower material security scores. Contrary to expectations that low levels of material security in this population would lead to poor ART adherence, we did not observe a significant relationship between adherence and overall material security score, as well as for each factor individually.

Our findings highlight the potentially important role of no-cost, universal access to HIV prevention and treatment, in mitigating the impact of socioeconomic disadvantage on ART adherence.

Registration timelines of antiretroviral medicines in Ghana and Kenya.

AIDS

: This study examines registration timelines of antiretroviral medicines (ARVs) in Ghana and Kenya, to assess whether prior reviews by the US Food ...

Assessing the validity of and factors that influence accurate self-reporting of HIV status after testing: a population-based study.

AIDS

To assess the validity of self-reported HIV status, and investigate factors that influence accurate reporting of HIV-positive status, in a population tested and informed of their HIV test result.

We compared self-reported HIV status to biomarker-confirmed HIV test status among participants of Karonga Health and Demographic Surveillance Site (HDSS) in rural northern Malawi. We linked information on HIV test results to subsequent self-reported HIV status, and calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for self-reported HIV status (considered as a diagnostic test). We used Poisson regression with robust variance estimators to examine predictors of accurate self-reporting of HIV-positive status.

Among 17,445adults who tested for HIV, were recorded as having received their HIV test results, and had a subsequent self-reported HIV status between 2007 and 2018: PPV of self-reported HIV status was 98.0% (95% confidence interval (CI): 97.3-98.7); NPV was 98.3 (98.1-98.5); sensitivity was 86.1% (84.5-87.7); and specificity was 99.8% (99.7-99.9). Among true HIV-positive people, those who were younger, interviewed in community settings, and had tested for HIV longer ago were more likely to misreport their HIV-positive status.

In this setting, self-report provides good estimates of test-detected HIV prevalence, suggesting that it can be used when HIV test results are not available. Despite frequent HIV testing, younger people and those interviewed in community settings were less likely to accurately report their HIV-positive status. More research on barriers to self-reporting of HIV status is needed in these sub-groups.

Productive HIV infection in astrocytes can be established via a non-classical mechanism.

AIDS

Astrocytes are proposed to be a critical reservoir of HIV in the brain. However, HIV infection of astrocytes is inefficient in vitro except for cell-to-cell transmission from HIV-infected cells. Here, we explore mechanisms by which cell-free HIV bypasses entry and post-entry barriers leading to a productive infection.

HIV infection of astrocytes was investigated by a variety of techniques including transfection of CD4-expressing plasmid, treatment with lysosomotropic agents or using a transwell culture system loaded with HIV-infected lymphocytes. Infection was monitored by HIV-1 p24 in culture supernatants and integrated proviral DNA was quantified by Alu-PCR.

Persistent HIV infection could be established in astrocytes by transfection of proviral DNA, transduction with VSV-G-pseudotyped viruses, transient expression of CD4 followed by HIV infection, or the infection treated with lysosomotropic chloroquine or Tat-HA2 peptide. In absence of these treatments, HIV entered via endocytosis as seen by electronmicroscopy and underwent lysosomal degradation without proviral integration, indicating endocytosis is a dead end for HIV in astrocytes. Nevertheless, productive infection was observed when astrocytes were in close proximity but physically separated from HIV-infected lymphocytes in the transwell cultures. This occurred with X4 or dual tropic R5X4 viruses and was blocked by an antibody or antagonist to CXCR4.

A CD4-independent, CXCR4-dependent mechanism of viral entry is proposed, by which immature HIV particles from infected lymphocytes might directly bind to CXCR4 on astrocytes and trigger virus-cell fusion during or after the process of viral maturation. This mechanism may contribute to the formation of brain HIV reservoirs.

Epidemiology and Burden of Food Allergy.

Current Allergy and Asthma Reports

In recent decades, food allergy has become an increasing concern for families, clinicians, and policymakers. This review aims to summarize what is currently known about the epidemiology and population-level burden of IgE-mediated food allergy, including its effects on quality of life.

Prevalence surveys, healthcare utilization data, and findings from longitudinal cohort studies across the globe indicate that food allergy imposes a growing societal burden. Worryingly, recent data indicate that food allergies may be more prevalent among adult populations than previously acknowledged, with many reported cases of adult-onset allergies. While it remains unclear how much of the current population-level burden of disease results from true, IgE-mediated allergy, as much epidemiological data does not incorporate clinical confirmation of disease prevalence-it is clear that affected individuals suffer impairments in their quality of life and incur substantial economic costs-beyond the physical health burden imposed by anaphylaxis.

HIV influences microtubule associated protein-2: Potential marker of HIV-associated neurocognitive disorders.

AIDS

Postmortem brains of subjects diagnosed with human immunodeficiency virus-1 (HIV) associated neurocognitive disorders (HAND) exhibit loss of dendrites. However, the mechanisms by which synapses are damaged are not fully understood.

First, we examined whether HIV affects MAP2 levels by analyzing the CSF of 27 persons living with HIV (PLH) whose neurocognitive performance had been characterized. We then used rat cortical neurons to study the mechanisms of HIV-mediated dendritic loss.

PLH who had HAND had greater MAP2 concentrations within the CSF than cognitive normal PLH. In cortical neurons, the deleterious effect of HIV on MAP2 positive dendrites occurred through a gp120-mediated mechanism. The neurotoxic effect of HIV was blocked by a CCR5 antagonist and prevented by Helix-A, a peptide that displaces gp120 from binding to MTs, conjugated to a nanolipoprotein particle delivery platform.

Our findings support that HIV at least partially effects its neurotoxicity via neuronal cytoskeleton modifications and provide evidence of a new therapeutic compound that could be used to prevent the HIV-associated neuropathology.

Hospital admissions in individuals with HTLV-1 infection in Spain.

AIDS

To examine the clinical burden and disease spectrum, as well as time trends for HTLV-1 and HTLV-2 hospital admissions.

Information for the diagnostic codes HTLV, -1 and -2 using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was retrieved from the national public registry since 1997 to 2015.

From a total of 66,462,136 nationwide hospital admissions recorded during the study period, 135 included HTLV diagnosis, being HTLV-1 in 115 (85.2%) and HTLV-2 in 20 (14.8%). The overall hospital admission rate due to HTLV was 2.03 per million, without significant yearly changes. First admissions represented 104 (77%) whereas 31 (23%) were re-admissions. The median in-hospital stay for HTLV patients was 9 days. In-hospital death occurred in 11 (8.1%). The median age of individuals with HTLV admission was 48 years-old and 60 (44.4%) were female. HTLV was recorded as the main diagnosis in 20%. The most frequent clinical conditions recorded alongside HTLV diagnosis were myelopathy (61; 45.2%), leukemia/lymphoma (30; 22.2%), solid organ transplantation (14; 10.4%) and child delivery (7; 5.2%).

The rate of HTLV diagnosis in hospitalized patients in Spain is low, roughly of 2 per million admissions. Despite continuous large immigrant flows from HTLV-1 endemic areas, no significant rising in hospitalizations due to HTLV-1 associated illnesses were noticed during the last two decades. Classical clinical complications of HTLV-1 infection, such as myelopathy and lymphoma account for more than two third of cases.

HIV nonoccupational postexposure prophylaxis (nPEP) for sexual assault cases: a three-year investigation.

AIDS

Nonoccupational postexposure prophylaxis (nPEP) programs offer antiretroviral therapy to prevent HIV following at-risk exposures like sexual assault. We investigated the levels of elective nPEP uptake among sexual assault cases presenting for emergency medical care.

The analysis included over 3 years (1Jan2015 to 30Sep2018) of clinic information from the Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital, the regional emergency department care point following sexual assault. Descriptive analyses assessed the number of cases eligible for nPEP and those who started nPEP. Bivariable/multivariable logistic regression modelling assessed factors most strongly associated with starting nPEP using odds ratios (OR), adjusted OR (AOR), and 95% confidence intervals (CI).

The SAPACP saw 1712 patients; 1032 were sexual assault cases, 494 were eligible for nPEP, and 307/494 (62%) eligible patients started nPEP. The median age was 23 years (IQR:20-31), with 446 (90%) cases being women. There were 86 (17%) cases who arrived by ambulance, and 279 (56%) assaults involving a known assailant. Reduced odds of starting nPEP were observed among female cases (AOR:0.44, 95% CI:0.21-0.93), those who arrived by ambulance (AOR:0.56, 95% CI:0.35-0.91), and those with a known assailant (AOR:0.56, 95% CI:0.36-0.78).

We found that 62% of eligible sexual assault cases started nPEP. Key groups most likely to decline nPEP included female cases, those who arrived by ambulance, and with known assailants. Providers can use these findings to provide recommendations to sexual assault survivors most likely to decline nPEP, yet still in need of care.

Beta amyloid levels in CSF of HIV-infected people vary by exposure to antiretroviral therapy.

AIDS

HIV-associated neurocognitive disorders (HAND) persist despite the widespread implementation of combined antiretroviral therapy (ART). As people with HIV (PWH) age on ART regimens, the risk of age-related comorbidities such as Alzheimer's disease (AD) may increase. However, questions remain as to whether HIV or ART will alter such risks. Beta amyloid (Aβ) and phosphorylated-tau (p-tau) proteins are associated with AD and their levels are altered in the CSF of AD cases.

To better understand how these AD-related markers are affected by HIV-infection and ART, postmortem CSF collected from 70 well-characterized HIV+ decedents was analyzed for Aβ1-42, Aβ1-40, and p-tau levels.

Aβ1-42 and Aβ1-40 CSF levels were higher in cases that were exposed to ART. Aβ1-42 and Aβ1-40 CSF levels were also higher in cases on protease inhibitors (PI) compared to those with no exposure to PIs. Aβ1-42 and Aβ1-40 levels in CSF were lowest in HIV+ cases with HIV-associated dementia (HAD) and levels were highest in those diagnosed with asymptomatic neurocognitive impairment (ANI) and minor neurocognitive disorder (MND). Aβ1-42 and Aβ1-40 were inversely related with p-tau levels in all cases, as previously reported.

These data suggest that ART exposure is associated with increased levels of Aβ1-42 and Aβ1-40 in the CSF. Also, HAD, but not ANI/MND diagnosis is associated with decreased levels of Aβ1-42 and Aβ1-40 in CSF, potentially suggesting impaired clearance. These data suggest that HIV infection and ART may impact pathogenic mechanisms involving Aβ1-42 and Aβ1-40, but not p-tau.

Increased monocyte and T-cell activation in treated HIV+ ugandan children: associations with gut alteration and HIV factors.

AIDS

The pathophysiology of immune activation and its mechanisms in children living with perinatally acquired HIV (PHIV) in sub-Saharan Africa has been understudied.

We enrolled 101 children living with perinatally acquired HIV (PHIV) and 96 HIV negative controls (HIV-). All participants were between 10-18 years of age with no known active infections. PHIVs were on ART with HIV-1 RNA level ≤400 copies/mL. We measured plasma and cellular markers of monocyte activation, T-cell activation (expression of CD38 and HLA-DR on CD4+ and CD8+), oxidized lipids, markers of gut integrity and fungal translocation. Spearman correlations and linear regression models were used.

Overall median (Q1; Q3) age was 13 years (11; 15) and 52% were females. Groups were similar by age, sex and BMI. Median ART duration was 10 years (8; 11). PHIVs had higher monocyte and T-cell activation; higher sCD14 (p = 0.01) and elevated frequencies of non-classical monocytes (p < 0.001 for both). Markers of systemic inflammation (hsCRP), fungal translocation (BDG), intestinal permeability (zonulin) and oxidized lipids (ox LDL) correlated with monocyte and T cell activation in PHIV (≤0.05). After adjusting for age, sex, ART duration, protease inhibitor and non-nucleoside reverse transcriptase inhibitor use, a modest association between BDG and activated CD4+ T cells was observed (β=0.65, p < 0.01). Oxidized LDL was inversely associated with activated T cells, inflammatory and non-classical monocytes (p < 0.01).

Ugandan children with perinatally acquired HIV with viral suppression have evidence of ongoing immune activation. Intestinal barrier dysfunction and fungal translocation may be involved in chronic immune dysfunction.